| PREVENTION BEST CURE FOR RENAL DISEASE |
Most people, including myself, have limited knowledge of kidney disease. Jokingly, my knowledge could have
been placed on the back of a postage stamp. Nevertheless, it is a very serious matter.
The National Kidney Foundation estimates that 20 million adults in the United States have some form of chronic,
kidney disease. However, most are unaware of this condition.
Of these figures, approximately 300,000 have stage 5 kidney failure, End Stage Renal Disease (ESRD), when the
kidney function is so severe that one will die within weeks or months unless dialysis, the process of removing
wastes or toxins from the blood, or a kidney transplant is given. 400,000 have stage 4 - severe, 7.5 million have
stage 3 - moderate and the remaining have stages 1 and 2 - kidney damage.
Dialysis Clinic Inc., DCI, is a non-profit organization formed in 1971 by a group of nephrologists from Nashville,
Tennessee. The corporation is currently operating 165 outpatient dialysis units in 25 states. The corporation
was organized for the welfare of society, the ESRD patient and not for individual profit.
The Charleston area has 7, DCI clinics, Charleston, West of the Ashley, Azalea Place, East of the Cooper,
Magnolia Court Home Program, James Island and Port Royal. Plans are underway for the opening of a Goose
Creek facility.
Every week in the Lowcountry, 1,000 patients come to the clinics for their treatments. Registered Nurse Karen
Delcioppo is the Assistant Director and Registered Nurse Jennifer Payton is the Home Training Coordinator for
the Charleston Clinic. They graciously provided a tour of the facility and gave some very informative instructions
on kidney disease, its prevention and treatment.
They stated an interesting fact, that most of the causes of kidney disease are related to the patient’s diabetes or
high blood pressure issues. These conditions may run in families and the person may not take the issues serious
enough. Some other causes of kidney disease are arteriosclerosis, lupus and inherited diseases.
Usually the person will not have symptoms until the “late” stages of kidney disease such as swelling, nausea,
vomiting, and shortness of breath. By this time, dialysis is needed. The nurses stressed the importance of
keeping other health issues under control to prevent kidney disease especially those in a high risk category.
The kidneys are two, bean-shaped organs, approximately the size of a fist which are responsible for removing
wastes and excess fluids from the body. The kidneys help control the mineral level, blood pressure and red
blood cells in the body.
Nurse Jennifer gave a good example, when a person drinks orange juice the kidneys will filter it and then send the
excess to the bladder. However, when a person’s kidneys are not functioning properly, the excess is retained in
the body and causes swelling and other problems.
The body is well designed when working properly. The kidneys know how much potassium from a liquid that the
body needs. When the kidneys are not functioning properly, too much potassium is retained and may cause
problems such as an irregular heartbeat. Generally, a dialysis patient is limited to 1,000cc of liquids a day.
Another concern for these patients is too much phosphorus in the body which causes the calcium levels to go
down. Protein, another important issue for renal patients, is closely monitored. The amount of protein varies
during the stages of treatment.
The nurses stressed the importance of diet in the patient’s health. The renal dietician plays an important role in
the treatment plan for these patients.
These patients are on numerous medicines which can include blood pressure, diabetes, phosphate binders,
vitamin supplements, stool softener, gastrointestinal and others.
The nurses explained that there are two types of dialysis, hemodialysis, via a vein and peritoneal dialysis, via the
peritoneal cavity in the abdomen or belly. Hemodialysis is a filtering system which filters out the blood. This
procedure is done at a clinic, 3 times a week for approximately 3 to 4 hours.
This procedure is via a machine in a comfortable recliner with nurses nearby monitoring the whole procedure.
Although, the patients do not move about, they may watch a small television connected to the unit.
Peritoneal dialysis can be performed at home. A catheter, a tube, is placed in the body and the extra waste
product is removed by a bag manually, which takes about 45 minutes and has to be done 4 times a day. Nurse
Jennifer teaches home dialysis to patients and their caretakers. She stated that she recently trained an 80, year
old couple to perform this procedure. Another option is for a machine to do the work while the person is
sleeping which takes 8 or 9 hours.
If the patient has dialysis in a clinic, the surgeon does a fistula or graft on the arm as there has to be a way to get
the blood out. The fistula is usually several inches long. The preferred method is to take a vein and artery and
attach them together to allow a larger vessel. This all sounds like a grueling process to endure, amazingly
though, both nurses relayed that the patients were positive and got along like family. When a person’s kidneys
can no longer function to keep one alive, this procedure then becomes a necessity.
The only other option is a kidney transplant which has rejection issues and may present other problems. A
transplant is not a cure, just another form of treatment. In fact, some have had more than one kidney transplant
due to failure. A donor may be from a person or a cadaver which is suited for transplantation to the patient.
The most important thing that the nurses wanted to stress is that kidney disease is preventable in most cases.
They recommended the following tests: a GFR test, glomerular filtration rate, which tells how quickly your kidneys
are cleaning your blood, a Creatinine Clearance test can determine how quickly that your kidneys clear your
blood of creatinine, a waste removed by healthy kidneys. Another test that can be performed by the primary care
physician is a Percent Kidney Function test which is an estimate of how much function the kidneys have left.
Those in high risk groups such as diabetics, on blood pressure medications, certain medications known to harm
the kidneys, exposure to certain chemicals and African Americans, should be monitored more frequently. African
Americans make up 75% of those in South Carolina on dialysis and need to be aware of the potential risks of
developing kidney disease. South Carolina is one of the 11 states which are referred to as the “stroke belt”
which can lead to kidney failure if not diagnosed and treated.
The current cost of dialysis is $60,000 to $70,000 per year, per patient which is usually paid by Medicare.
However, there are numerous prescriptions which are not totally covered. According to the clinic personnel, the
number of persons on dialysis is expected to double in the next several years thus placing a greater demand on
the Medicare system.
To avoid this financial drain, to maintain health and prevent suffering, the prevention of this disease is the best
choice available.
